Thursday, February 23, 2012

How to have a lumpectomy, Part 2

Oh, but wait! You really should read Part 1 first!

So, secure in the knowledge that my sentinel node was mapped, I went back into the waiting room of the nuclear medicine department. A nurse mentioned that my surgery had been moved forward, and that instead of the 2+ hours that we thought we had left to wait, someone was coming now to collect my charts and take us up to pre-op. Oh! Oh.

This made me a little nervous...I had been thinking I'd more idle time on my hands for magazine reading. It felt a little like preparing for your scene in the third act and then finding out the director was skipping the second. You're on! But really, it was a good thing. Why delay it if you don't have to? Plus, I knew that it would be better for our families, anxiously waiting back in the States, where it was already creeping towards dinnertime.

We went back upstairs, I got back in my little bed with the warm blanket. A nice young guy came and wheeled me away, Jason following. Again, I felt silly being wheeled around, when I knew I could walk on my own. I suppose it's easier for the hospital staff, but it's like I wanted to get down and do some pushups, just to show I could.

And then it was all a flurry, really. The surgeon and team were whipping through their schedule for the day, and I was next. The anesthesiologist came over to meet me and ask me a bunch of questions, I signed forms, I put on a fetching paper cap to match my undies. And then the nurse asked if I was ready. Jason kissed me--and for the first time he looked a little forlorn. Standing there, holding my purse, with me being wheeled off. "Hey--go get a coffee," I said to him, "I know you've been dying for one! I'll see you soon."

I was wheeled to the little anteroom right outside the operating theatre. I could see my doctor in there, getting ready, and the anesthesiologist came over to put my IV in. There were a lot of people, and there was a hum of efficiency. I could hear music--it sounded like Johnny Cash--playing. "We usually have a little music going, is that alright with you?" he asked. I told him it was fine, after all, I wouldn't be awake to hear much of it. "Hey," I said, "Is everyone feeling good? Y'all had a healthy breakfast? Everybody happy?" "We're doing great," my surgeon said, "We could do this all day." "That's good to hear!" I said. I don't know why I felt the urge to, like, warm up the crowd. It's this thing I do--get all chatty when I'm nervous. Actually, I tend to get chatty whether I'm nervous or not. As if the burden to entertain is all on me? I'm surprised I didn't perform a stand-up routine. Thank God.

They brought me into the operating theatre, and I shimmied onto the operating table. Somebody gave me a shot of something. I remember wanting to stay awake a little longer. Not because I worried about being unconscious, but because I sort of enjoyed watching everyone work. That sounds totally bizarre now that I've written it down, but I noticed this same thing when I had the biopsy done. There's this part of you that's detached from the fact that all this is happening to you, and you're just interested in the process. I just wanted to look around for a bit.

Now, a technical sidenote, if you're interested. This is my understanding of the usual procedure for lumpectomies. Once the surgeon opens you up, he/she removes the sentinel node first. That's sent to pathology right away--to look for cancer cells. The aim is them to remove the tumor, with a sliver of healthy tissue on each side. This is called a "margin". There's no standard rule for how much of a margin to get--the idea is to get healthy tissue on either side so you know you've gotten the whole mass. My doctor told us he aims to get 1-2mm margins. Once the procedure is over, that's sent off for analysis, to ensure that the margins are clear--meaning cancer-free. If they're not, then they have to schedule another surgery to go back in.

Before the lumpectomy is complete, the initial result on the sentinel node is reported back. If it's cancer-free, as it was in my case, then that's all that is done. If the node had cancer cells, like it was with Becky, then the surgeon does what's called axillary dissection. This is when more lymph nodes are removed from your armpit for analysis. The number of nodes removed varies, but I was told it's usually between 2-9. This is of course more invasive and will require a surgical drain and a longer recovery time.

Anyway, the next thing I remember is the doctor calling my name, and me opening my eyes in recovery. He said something about no node involvement, and I murmured a response. Then he was gone, and I texted everyone. Then I opened my eyes again and realized...of course I hadn't texted everyone! I didn't have my phone. I'd dreamed that bit. So then I got confused if I'd actually talked to the doctor, or if I'd imagined the whole thing. Trippy!

Pretty quickly upon gaining consciousness, I felt a burny-throbby-scratchy pain on the side of my breast. It felt angry to me, in my hazy state of mind. A nurse came and asked me if I wanted some morphine. Um, duh? Sure! Why not? I'd say the pain was about a 7, on a scale of 1-10. But the nurse kept coming over and asking how my pain was, and kept topping off the morphine. So within about half an hour, I barely noticed it--maybe down to a 2. Another nurse came and asked me if I wanted to stay overnight--the doctor had said I could go home if I wanted to. I was so groggy, I was having a hard time making the decision. "You have young children, don't you?" she asked. Yes, I told her. "You should stay here tonight. It's better," she said firmly. Sometimes, it's really nice to have someone else tell you what to do. Yes, I said. I'll stay tonight.

And it was a good thing I did! I was very dizzy from the medication the rest of the day and into the evening. I couldn't lift my head without the room spinning. I guess all those drugs come at a price.

Recovery has been pretty smooth. I think I'm lucky...I only had one node removed, so I don't need a surgical drain, and my surgery was a lot less invasive than it could've been. The surgery was Friday; by Sunday I was up and about in the house. Doing laundry--seriously, what is wrong with me?

And Jason has been juicing. Juicing everything in sight and making me drink it. More on that later, my pretties. I have talked long enough, of boobs and boob-related issues.


  1. Straw Poll of Matron Down Under and Suburban Matron readers: Should these two sisters collaborate on a book detailing breast cancer treatment? Two sisters, two continents, two procedures, two health care systems. Seems like a natural to me.

    See you soon, sweetie.

    1. Two sisters, two continents, two boobs. Or wait--technically four boobs. Now I'm getting confused.

    2. You MUST write that book. Insta-best-seller. Guar-UN-teed.

  2. My vote in the poll: probably!

    Amy, does Australia have a similar national healthcare system to the UK? I think in one of your posts you mentioned paying a bill so I was a little confused. Also, how big is a lymph node? I'm picturing something like a quail's egg but that can't be right...

    1. Haha! "Probably" is a bit how I feel about it, too. Or, "maybe". :)

      We do have a national healthcare system, Medicare. But many people, us included, also have private health insurance, so you can opt to go through the private system. However, Medicare still rebates about 80-85% of our expenses, and our insurance picks up some as well. We opted to go private for the surgery so that I could choose the surgeon that would do the operation. But for treatment, we'll probably go public. Still figuring it all out as we go!

      I will say though, that I have been so well looked after in the public system, with having two kids here. And even in this ordeal, I have been followed up by public health nurses--they're really wonderful.

      How big is a lymph node? I think it varies, but these are smaller, I got the idea they're maybe pea sized? I just looked it up--it says most normal ones are 1-2cm in size, but that can vary depending on their location in the body. Of course, they can get enlarged if you're sick.

    2. I said 'probably' rather than 'obviously' only because I'm guessing it would be a LOT of work! But it would certainly be a good read!

      Interesting about your healthcare system - quite different to ours.

  3. Camp Papa: These two could imbue a phone book with hilarity: Atlantan or Australian. Please make them write a book or several---on any topic!!!!

  4. It's such a good feeling to be in the hands of good competent people who know what they are doing, isn't it? And bless that nurse for telling you that you should stay for the night. Johnny Cash huh? Once again your writing makes such an interesting read. We will be there soon!

  5. YES on the book! You can both stay with me when you hit Seattle for the book signing tour.

    I'm totally with you on the whole surgery procedure. I find the process fascinating, and the in-and-out-ness of anesthesia is even more fascinating. I mean, one minute, they're telling you to count down from 100 (I got to 98) or sing Ramblin' Wreck (probably not in Australia), and the next, you're in a totally different room, with weird pain, and they're offering you a Coke.

    1. Yes! It's really so bizarre, isn't it? I don't even think they had me count, I was just gone! I remember when Ava had minor surgery when she was 2. I held her while they had her breathe the gas in to put her to sleep. And when she was out, in my arms, I realized it was a very different state than simply being asleep. She was well and truly OUT. That was a strange thing to see in your little girl. ;)

  6. YES on the book! I would ordinarily think this stuff would be awful to read about, but I love reading Amy and Becky's takes on it all!

  7. I'm interested in the differences of the 2 medical systems, being Australian I want to say 'ours is better!' but we'll see if Amy thinks so.
    Just having had an anaesthetic for a nose op the weird part was knowing the next thing I would be aware of would be waking up having the last hour magically disappear. I kept stopping myself from saying 'Micheal Jackson me' probably good I didn't.

  8. In all honestly, you really should collaborate on a book together. I think the sister thing, different continents, both sociologists of the suburbs... it's perfect. Too bad I'm not a publisher!